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2022-IAH Intake Form

Please take time to complete this form. Should you have questions, please contact us at 501-221-2203. ONLY COMPLETE THIS FORM AFTER YOU HAVE PAID. CLICK HERE  IF YOU NEED TO PAY.

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Email *
First Name *
Last Name *
Street Address 1 *
Street Address 2
City *
State *
Zip *
County *
Best contact phone? *
Service type (check all that apply) *
Name of Co-Applicant
Who referred you? *
Race *
Ethnicity *
Number in household? *
Do you live in a rural area (areas with 49,999 or less) *
Are you proficient in English *
Date of birth? *
Are you a first-time homebuyer? 

HUD states that first-time homebuyer is an individual who meets any of the following criteria:

An individual who has had no ownership in a principal residence during the 3-year period ending on the date of purchase of the property. 

This includes a spouse (if either meets the above test, they are considered first-time homebuyers).
A single parent who has only owned with a former spouse while married;
An individual who is a displaced homemaker and has only owned with a spouse;
An individual who has only owned a principal residence not permanently affixed to a permanent foundation in accordance with applicable regulations; or
An individual who has only owned a property that was not in compliance with state, local or model building codes and which cannot be brought into compliance for less than the cost of constructing a permanent structure.
Marital Status
Current living situation? *
Active duty military *
Veteran Status *
Annual household Income *
How did you hear about us? (check all that apply). *
REASON FOR ATTENDING CLASS (check all that apply) *
Do you have a bank?
Clear selection
If no, are you looking for a bank? Please note that when seeking a mortgage, most lenders will require that you  demonstrate that you  "reserves."  A bank account can greatly assist during this process.
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A copy of your responses will be emailed to the address you provided.
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